Healthcare Provider Details

I. General information

NPI: 1306587167
Provider Name (Legal Business Name): RETRAC ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/02/2025
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 N GREEN BAY AVE
MILWAUKEE WI
53209-7019
US

IV. Provider business mailing address

4117 N GREEN BAY AVE
MILWAUKEE WI
53209-7019
US

V. Phone/Fax

Practice location:
  • Phone: 414-433-0780
  • Fax: 414-433-5780
Mailing address:
  • Phone: 414-218-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: AMBER ELLIS
Title or Position: OWNER
Credential: PHYSICIAN ASSISTANT
Phone: 414-218-8670